Provider Demographics
NPI:1588369516
Name:JOHNSON, ANDREA LYNN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18313 NEWELL RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5051
Mailing Address - Country:US
Mailing Address - Phone:310-864-0100
Mailing Address - Fax:
Practice Address - Street 1:18313 NEWELL RD
Practice Address - Street 2:
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5051
Practice Address - Country:US
Practice Address - Phone:310-864-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach